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Alhammad SA. Advocating for Action: Exploring the Potential of Virtual Reality in Breathing Exercise - A Review of The Clinical Applications. Patient Prefer Adherence 2024; 18:695-707. [PMID: 38524197 PMCID: PMC10960537 DOI: 10.2147/ppa.s451609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 03/13/2024] [Indexed: 03/26/2024] Open
Abstract
The emergence of virtual reality (VR) technologies is currently shaping the healthcare system and is now being employed in various healthcare interventions. Pulmonary rehabilitation remains one such area in which VR is currently thriving to ensure overall health and well-being. While the importance of these novel technologies is being primarily researched in pulmonary rehabilitation, especially over passive conventional breathing exercise training, there seems to be a limited number of studies that have comprehensively put together these findings. This study utilizes a scoping review methodology to review VR exercises in clinical settings related to pulmonary rehabilitation. To achieve this objective, three electronic databases (Web of Science, PubMed, and Cochrane Library) were searched using a formulated search string related to the research objective. Following the database search, a total of 236 references were retrieved and managed using the reference manager. The screening of references was conducted according to the PRISMA 2020 screening process, and their quality was assessed using the JBI checklist. Ultimately, a total of eight publications of high quality were selected for inclusion in the scoping review. The results of the synthesis validate the importance of utilizing VR in the context of breathing exercise in rehabilitation. The effectiveness and rapid development of VR breathing exercises are primarily attributed to the engaging and immersive experience they provide. The use of biofeedback and self-regulation techniques into VR exercise systems was also seen to have a notable impact on the effectiveness of the breathing exercise system.
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Affiliation(s)
- Saad A Alhammad
- Department of Rehabilitation Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Kingdom of Saudi Arabia
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2
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Liang Y, Chen S, Song J, Deng T, Yang J, Long Y, Suen LKP, Luo X. The effect of incentive spirometry in perioperative patients with lung cancer-a systematic review and meta-analysis. BMC Pulm Med 2024; 24:88. [PMID: 38360672 PMCID: PMC10870616 DOI: 10.1186/s12890-024-02878-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Accepted: 01/24/2024] [Indexed: 02/17/2024] Open
Abstract
BACKGROUND Incentive spirometry (IS) as a routine respiratory therapy during the perioperative period has been widely used in clinical practice. However, the impact of IS on patients with perioperative lung cancer remains controversial. This review aimed to evaluate the efficacy of IS in perioperative pulmonary rehabilitation for patients with lung cancer. METHODS Cochrane Library, PubMed, Web of Science, Ovid, CINAHL, Chinese National Knowledge Infrastructure, Weipu, and Wanfang Databases were searched from inception to 30 November 2023. Only randomized controlled trials were included in this systematic review. The PRISMA checklist served as the guidance for conducting this review. The quality assessment of the included studies was assessed by the Cochrane risk-of-bias tool. The meta-analysis was carried out utilizing Review Manager 5.4. Furthermore, sensitivity analysis and subgroup analysis were also performed. RESULTS Nine studies recruited 1209 patients met our inclusion criteria. IS combined with other respiratory therapy techniques was observed to reduce the incidence of postoperative pulmonary complications, enhance pulmonary function, curtail the length of hospital stay, and lower the Borg score. Nevertheless, no improvements were found in the six-minute walk distance or quality of life score. CONCLUSIONS Although IS demonstrates benefits as a component of comprehensive intervention measures for perioperative patients with lung cancer, it proves challenging to determine the precise impact of IS as a standalone component within the comprehensive intervention measures. Therefore, further researches are required to better understand the effectiveness of IS isolation and its interactions when integrated with additional respiratory therapies for these patients. CLINICAL TRIAL REGISTRATION PROSPERO, https://www.crd.york.ac.uk/prospero/ , registry number: CRD42022321044.
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Affiliation(s)
- Yan Liang
- Nursing Department, Affiliated Hospital of Zunyi Medical University, No. 149, Dalian Road, Huichuan District, Zunyi City, Guizhou Province, 563000, China
- School of Nursing, Zunyi Medical University, No 6, Xuefu West Road, Zunyi City, Guizhou Province, 563000, China
| | - Shaolin Chen
- Nursing Department, Affiliated Hospital of Zunyi Medical University, No. 149, Dalian Road, Huichuan District, Zunyi City, Guizhou Province, 563000, China
- School of Nursing, Zunyi Medical University, No 6, Xuefu West Road, Zunyi City, Guizhou Province, 563000, China
| | - Jiamei Song
- Nursing Department, Affiliated Hospital of Zunyi Medical University, No. 149, Dalian Road, Huichuan District, Zunyi City, Guizhou Province, 563000, China
- School of Nursing, Zunyi Medical University, No 6, Xuefu West Road, Zunyi City, Guizhou Province, 563000, China
| | - Ting Deng
- Nursing Department, Affiliated Hospital of Zunyi Medical University, No. 149, Dalian Road, Huichuan District, Zunyi City, Guizhou Province, 563000, China
- School of Nursing, Zunyi Medical University, No 6, Xuefu West Road, Zunyi City, Guizhou Province, 563000, China
| | - Jinfen Yang
- Nursing Department, Affiliated Hospital of Zunyi Medical University, No. 149, Dalian Road, Huichuan District, Zunyi City, Guizhou Province, 563000, China
- School of Nursing, Zunyi Medical University, No 6, Xuefu West Road, Zunyi City, Guizhou Province, 563000, China
| | - Yangyang Long
- School of Nursing, Zunyi Medical University, No 6, Xuefu West Road, Zunyi City, Guizhou Province, 563000, China
| | | | - Xu Luo
- School of Medical Informatics and Engineering, Zunyi Medical University, No 6, Xuefu West Road, Zunyi City, Guizhou Province, 563000, China.
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3
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Bingül ES, Şentürk NM, Kaynar AM. Prehabilitation: a narrative review focused on exercise therapy for the prevention of postoperative pulmonary complications following lung resection. Front Med (Lausanne) 2023; 10:1196981. [PMID: 37849492 PMCID: PMC10577193 DOI: 10.3389/fmed.2023.1196981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 09/15/2023] [Indexed: 10/19/2023] Open
Abstract
Extensive preventive strategies in the perioperative period are popular worldwide. Novel "prehabilitation" approaches are being defined for every individual surgical discipline. With intention to reduce perioperative morbidity, "prehabilitation" was developed to increase "physical wellness" considering exercise capacity, nutritional status, and psychological support. Thus, prehabilitation could be well-suited for patients undergoing lung cancer surgery. Theoretically, improving physical condition may increase the chances of having a better post-operative course, especially among frail patients. In this review, we describe the concept of prehabilitation with possible benefits, its role in the Enhanced Recovery After Surgery protocols, and its potential for the future.
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Affiliation(s)
- Emre Sertaç Bingül
- Department of Anesthesiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Türkiye
| | - Nüzhet Mert Şentürk
- Department of Anesthesiology, Acibadem University School of Medicine, Istanbul, Türkiye
| | - Ata Murat Kaynar
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, PA, United States
- The Center for Innovation in Pain Care (CIPC), University of Pittsburgh, Pittsburgh, PA, United States
- Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, United States
- The Clinical Research, Investigation, and Systems Modeling of Acute Illness (CRISMA) Center, University of Pittsburgh, Pittsburgh, PA, United States
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4
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Chang PC, Chen PH, Chang TH, Chen KH, Jhou HJ, Chou SH, Chang TW. Incentive spirometry is an effective strategy to improve the quality of postoperative care in patients. Asian J Surg 2023; 46:3397-3404. [PMID: 36437210 DOI: 10.1016/j.asjsur.2022.11.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 10/15/2022] [Accepted: 11/11/2022] [Indexed: 11/27/2022] Open
Abstract
Postoperative pulmonary complications (PPCs) most commonly occur after thoracic surgery. Not only prolonged hospital stay and increased financial expenses but also morbidity and even mortality may be troublesome for those with PPCs. Herein, we aimed to conduct a comprehensive systematic review and meta-analysis of available data to examine the effectiveness of incentive spirometry (IS) to reduce PPCs and shorten hospital stay. This systematic review and meta-analysis included 5 randomized controlled trials (RCT) and 3 retrospective cohort study (10,322 patients in total) in PubMed, Embase and Cochrane Library until September 31, 2021. We assessed the clinical efficacy of IS using length of hospital stay, PPCs, postoperative pneumonia, and postoperative atelectasis with meta-analysis, meta-regression and trial sequential analysis (TSA). With this meta-analysis, the length of hospital stay in patients undergoing IS was significantly shorter (1.8 days) than that in patients not receiving IS (MD = -1.80, 95% CI = -2.95 to -0.65). Patients undergoing IS also had reduced risk of PPCs (32%) and postoperative pneumonia (17.9%) with statistical significance than patients not undergoing IS (PPC: OR = 0.68, 95% CI = 0.51-0.90) (Pneumonia: OR = 0.821, 95% CI = 0.677-0.995).In meta-regression, the benefits of undergoing IS in patients with preoperative predicted FEV1 of <80% in a linear fashion with decreasing PPCs. IS is an effective modality to improve the quality of postoperative care for patients after pulmonary resection, compared with the control group without using IS; and applying IS has favorable outcomes of shorter length of hospital stay (1.8 days) and lower occurrence of PPCs (32% of risk reduction), which are conclusive and robust based on our validation via TSA. Moreover, the IS device is more beneficial for patients with preoperative predicted FEV1 of <80% than that in others.
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Affiliation(s)
- Po-Chih Chang
- Division of Thoracic Surgery, Department of Surgery, Kaohsiung Medical University Hospital/Kaohsiung Medical University, Kaohsiung City, Taiwan; Weight Management Center, Kaohsiung Medical University Hospital/Kaohsiung Medical University, Kaohsiung City, Taiwan; Ph. D. Program in Biomedical Engineering, College of Medicine, Kaohsiung Medical University, Kaohsiung City, Taiwan; Department of Sports Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung City, Taiwan
| | - Po-Huang Chen
- Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei City, Taiwan
| | - Ting-Hsuan Chang
- School of Medicine, China Medical University, Taichung City, Taiwan
| | - Kai-Hua Chen
- Department of Surgery, Kaohsiung Medical University Hospital/Kaohsiung Medical University, Kaohsiung City, Taiwan
| | - Hong-Jie Jhou
- Department of Neurology, Changhua Christian Hospital, Changhua, Taiwan
| | - Shah-Hwa Chou
- Division of Thoracic Surgery, Department of Surgery, Kaohsiung Medical University Hospital/Kaohsiung Medical University, Kaohsiung City, Taiwan; Department of Surgery, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung City, Taiwan
| | - Ting-Wei Chang
- Division of Thoracic Surgery, Department of Surgery, Kaohsiung Medical University Hospital/Kaohsiung Medical University, Kaohsiung City, Taiwan.
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5
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Park A, Orlandini MF, Szor DJ, Junior UR, Tustumi F. The impact of sarcopenia on esophagectomy for cancer: a systematic review and meta-analysis. BMC Surg 2023; 23:240. [PMID: 37592262 PMCID: PMC10433615 DOI: 10.1186/s12893-023-02149-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 08/10/2023] [Indexed: 08/19/2023] Open
Abstract
BACKGROUND Esophagectomy is the gold-standard treatment for locally advanced esophageal cancer but has high morbimortality rates. Sarcopenia is a common comorbidity in cancer patients. The exact burden of sarcopenia in esophagectomy outcomes remains unclear. Therefore, this systematic review and meta-analysis were performed to establish the impact of sarcopenia on postoperative outcomes of esophagectomy for cancer. METHODS We performed a systematic review and meta-analysis comparing sarcopenic with non-sarcopenic patients before esophagectomy for cancer (Registration number: CRD42021270332). An electronic search was conducted on Embase, PubMed, Cochrane, and LILACS, alongside a manual search of the references. The inclusion criteria were cohorts, case series, and clinical trials; adult patients; studies evaluating patients with sarcopenia undergoing esophagectomy or gastroesophagectomy for cancer; and studies that analyze relevant outcomes. The exclusion criteria were letters, editorials, congress abstracts, case reports, reviews, cross-sectional studies, patients undergoing surgery for benign conditions, and animal studies. The meta-analysis was synthesized with forest plots. RESULTS The meta-analysis included 40 studies. Sarcopenia was significantly associated with increased postoperative complications (RD: 0.08; 95% CI: 0.02 to 0.14), severe complications (RD: 0.11; 95% CI: 0.04 to 0.19), and pneumonia (RD: 0.13; 95% CI: 0.09 to 0.18). Patients with sarcopenia had a lower probability of survival at a 3-year follow-up (RD: -0.16; 95% CI: -0.23 to -0.10). CONCLUSION Preoperative sarcopenia imposes a higher risk for overall complications and severe complications. Besides, patients with sarcopenia had a lower chance of long-term survival.
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Affiliation(s)
- Amanda Park
- Department of Gastroenterology, Universidade de São Paulo (USP), São Paulo, São Paulo, Brazil
- Centre for Evidence-Based Medicine, Centro Universitário Lusíada (UNILUS), Santos, Brazil
| | - Marina Feliciano Orlandini
- Department of Gastroenterology, Universidade de São Paulo (USP), São Paulo, São Paulo, Brazil
- Centre for Evidence-Based Medicine, Centro Universitário Lusíada (UNILUS), Santos, Brazil
| | - Daniel José Szor
- Department of Gastroenterology, Universidade de São Paulo (USP), São Paulo, São Paulo, Brazil
| | - Ulysses Ribeiro Junior
- Department of Gastroenterology, Universidade de São Paulo (USP), São Paulo, São Paulo, Brazil
| | - Francisco Tustumi
- Department of Gastroenterology, Universidade de São Paulo (USP), São Paulo, São Paulo, Brazil.
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6
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Ganapathy A, Ballard DH, Bishop GL, Hoegger MJ, Abraham N, D’Agostino HB. Pilot Study on the Influence of Incentive Spirometry on Percutaneous Image-Guided Intra-Abdominal Drainage Catheter Pressure: A Potential Method to Enhance Drainage. APPLIED SCIENCES (BASEL, SWITZERLAND) 2023; 13:7308. [PMID: 37621554 PMCID: PMC10448541 DOI: 10.3390/app13127308] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/26/2023]
Abstract
Background To report the evaluation of incentive spirometry (IS)-induced pressure changes in intra-abdominal drainage catheters and consider its use for maintaining catheter patency and enhancing drainage. Methods Prospective study of patients with indwelling intra-abdominal drainage catheters for abdominal fluid collections who had their intra-abdominal pressures measured while performing incentive spirometry. Patients were instructed in the use of an incentive spirometer. Within a week after initial drainage, pressure changes with IS were evaluated three times at 1500 cc and three times at maximum inspiratory effort. Intra-abdominal pressure (IAP) was measured using a pressure monitor connected to the drainage catheter. Results Twenty patients (men, 12; women, 8). Fluid collection locations were pelvis, Right-upper quadrant (RUQ), Left-upper quadrant (LUQ), Left-lower quadrant (LLQ), and Right-lower quadrant (RLQ). A total of 16 of 20 patients showed an elevation of IAP with IS. At 1500 cc, the pressure increased by an average of 41.24 mmH2O. At maximal inspiratory effort, the pressure increased by an average of 48.26 mmH2O. Pressure increase was greater in upper abdomen catheters. Four patients with lower abdominal and pelvic collections showed minimal pressure changes with IS. Conclusion IS increases IAP and fluid flow through abdominal drainage catheters. Future studies are warranted to determine whether the use of IS enhances catheter performance and facilitates drainage via its effect on IAP.
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Affiliation(s)
- Aravinda Ganapathy
- School of Medicine, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - David H. Ballard
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Grace L. Bishop
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Mark J. Hoegger
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Nihil Abraham
- Department of Internal Medicine, University of California Riverside School of Medicine, Riverside, CA 92521, USA
| | - Horacio B. D’Agostino
- Department of Radiology, Louisiana State University Health Shreveport, 1501 Kings Highway, Shreveport, LA 71103, USA
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7
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Bertolaccini L, Mohamed S, Uslenghi C, Chiari M, Girelli L, Lo Iacono G, Spaggiari L. A Practical Assessment of the Postoperative Management in Lung Cancer Surgery. J Pers Med 2023; 13:jpm13020358. [PMID: 36836592 PMCID: PMC9963681 DOI: 10.3390/jpm13020358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 02/12/2023] [Accepted: 02/15/2023] [Indexed: 02/22/2023] Open
Abstract
Postoperative management after major and minor thoracic surgeries is crucial for patient recovery and can be challenging. Major thoracic surgeries, such as extensive pulmonary resections, especially in patients with poor health status, may require intensive surveillance, particularly during the first 24-72 h after surgery. Moreover, thanks to the demographic development and medical progress in perioperative medicine, more patients with comorbidities undergoing thoracic procedures require proper management in the postoperative period to improve prognosis and decrease hospital stay. Here, we summarize the main thoracic postoperative complications in order to clarify how to prevent them through a series of standardized procedures.
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Affiliation(s)
- Luca Bertolaccini
- Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141 Milan, Italy
- Correspondence: ; Tel.: +39-02-57489665; Fax: +39-02-56562994
| | - Shehab Mohamed
- Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141 Milan, Italy
| | - Clarissa Uslenghi
- Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141 Milan, Italy
| | - Matteo Chiari
- Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141 Milan, Italy
| | - Lara Girelli
- Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141 Milan, Italy
| | - Giorgio Lo Iacono
- Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141 Milan, Italy
| | - Lorenzo Spaggiari
- Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141 Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy
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8
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Su H, Zhang J, Liu Y, Peng H, Zhang L. Pre and postoperative nurse-guided incentive spirometry versus physiotherapist-guided pre and postoperative breathing exercises in patients undergoing cardiac surgery: An evaluation of postoperative complications and length of hospital stay. Medicine (Baltimore) 2022; 101:e32443. [PMID: 36596066 PMCID: PMC9803493 DOI: 10.1097/md.0000000000032443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Atelectasis is the most occurring postoperative complication after cardiac surgeries. Postoperative respiratory exercises and incentive spirometry led to decrease in postoperative complications, especially atelectasis and hospital stay. The objectives of the study were to evaluate postoperative complications and length of hospital stay of patients who received pre and postoperative nurse-guided incentive spirometry against those of patients who received pre and postoperative breathing exercises by the physiotherapist in patients who underwent cardiac surgery. Data of patients who received 2 days preoperative and 2 days postoperative nurse-guided incentive spirometry with a spirometer (PPN cohort, n = 102) or received 2 days preoperative and 2 days postoperative breathing exercises by physiotherapist without spirometer (PPP cohort, n = 105), or 2 days postoperative physiotherapist-guided breathing exercises only without spirometer (PPB cohort, n = 114) were collected and analyzed. The acute or chronic collapse of part or entire lung was defined as atelectasis. The length of stay in the hospital was from the day of admission to discharge. Patients of the PPN cohort had fewer numbers of incidences of atelectasis, dyspnea, and sweating >1 day after operations compared to those of the PPB and the PPP cohorts (P < .05 for all). The partial pressure of oxygen and oxygen saturation of arterial blood ≥6 hours after operations reported higher, the duration of ventilation was shorter, and numbers of re-intubation processes reported fewer for patients of the PPN cohort than those of the PPB and the PPP cohorts (P < .05 for all). The hospital length of the stay of patients in the PPN cohort was fewer than those of the PPB and the PPP (P < .0001 for both) cohorts. Pre and postoperative nurse-guided incentive spirometry with a spirometer following cardiac surgeries would have better postoperative pulmonary outcomes and fewer hospital stays than those of postoperative-only or pre and postoperative physiotherapist-guided breathing exercises (level of evidence: IV; technical efficacy stage: 5).
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Affiliation(s)
- Hui Su
- Department of Cardiac Surgery, Xingtai People’s Hospital, Xingtai, Hebei, China
- * Correspondence: Hui Su, Department of Cardiac Surgery, Xingtai People’s Hospital, No. 818 of Xiangdu North Road, Xingtai, Hebei 054001, China (e-mail: )
| | - Jun Zhang
- Department of Cardiac Surgery, Xingtai People’s Hospital, Xingtai, Hebei, China
| | - Yunxue Liu
- Department of Cardiac Surgery, Xingtai People’s Hospital, Xingtai, Hebei, China
| | - Hui Peng
- Department of Cardiac Surgery, Xingtai People’s Hospital, Xingtai, Hebei, China
| | - Longfei Zhang
- Department of Cardiac Surgery, Xingtai People’s Hospital, Xingtai, Hebei, China
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9
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Smith C, Schneider M, Pitzer B, Hlodash G. Reviving a successful blunt chest wall injury protocol. Nursing 2022; 52:53-57. [PMID: 36394627 DOI: 10.1097/01.nurse.0000891940.64357.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
This article describes a quality improvement project that assessed nurses' knowledge and practices for patients admitted with a blunt chest wall injury and utilized interactive learning to revive the use of the protocol.
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Affiliation(s)
- Carolyn Smith
- Carolyn Smith is an assistant professor of Nursing at York College of PA in York, Pa., and an RN at Wellspan York Hospital in York, Pa. Melissa A. Schneider is a nursing faculty at York College and a clinical nurse educator at Wellspan York Hospital, where Brittney Pitzer and George Hlodash are clinical RNs
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10
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Lai K, Lee J, Notrica DM, Egan JC, McMahon LE, Molitor MS, Bae JO, Ostlie DJ, Padilla BE. Intercostal Nerve Cryoablation in Minimally Invasive Repair of Pectus Excavatum: Effect on Pulmonary Function. J Laparoendosc Adv Surg Tech A 2022; 32:1244-1248. [PMID: 36350702 DOI: 10.1089/lap.2022.0242] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Introduction: Cryoablation of intercostal nerves is performed for pain control after minimally invasive repair of pectus excavatum (MIRPE). Cryoablation affects both sensory and motor neurons, resulting in temporary anesthesia to the chest wall and loss of intercostal motor function. The study objective is to determine the effect of cryoablation on incentive spirometry (IS) volumes, as a measure of pulmonary function, after MIRPE. Materials and Methods: A single-institution retrospective review of pediatric patients undergoing MIRPE was performed. All patients received a multimodal regimen (MMR) of analgesics postoperatively. Three groups were compared-cryoablation (CRYO), elastomeric pain pump (EPP), and MMR alone. The primary outcomes were postoperative IS volumes and IS volumes as a ratio of preoperative forced vital capacity (FVC). Secondary outcomes included pain scores, opioid use, length of stay (LOS), and infectious complications. Results: MIRPE was performed in 115 patients: 50 CRYO, 50 EPP, and 15 MMR alone. Groups were similar for demographics and pectus excavatum severity. Postoperative spirometry measurements were similar across groups: IS (CRYO 750 mL [500,961] versus EPP 750 mL [590,1019] versus MMR 696 mL [500,1037], P = .77); IS/FVC (CRYO 0.19 [0.14,0.26] versus EPP 0.20 [0.16,0.26] versus MMR 0.16 [0.15,0.24], P = .69). Although pain scores were also similar across groups, CRYO patients used less opioid (P < .05) and had shorter LOS (P < .05). Postoperative pneumonia was rare and similar across groups (P = 1.00). Conclusion: Intercostal nerve cryoablation during MIRPE does not adversely affect postoperative IS volumes or increase pneumonia rate, despite the temporary loss of motor innervation to intercostal muscles. Cryoablation provides effective pain control with less opioid use.
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Affiliation(s)
- Krista Lai
- Division of Pediatric Surgery, Phoenix Children's Hospital, Phoenix, Arizona, USA
| | - Justin Lee
- Division of Pediatric Surgery, Phoenix Children's Hospital, Phoenix, Arizona, USA.,Department of Child Health, University of Arizona College of Medicine-Phoenix, Phoenix, Arizona, USA.,Department of Surgery, Mayo Clinic College of Medicine and Science, Phoenix, Arizona, USA
| | - David M Notrica
- Division of Pediatric Surgery, Phoenix Children's Hospital, Phoenix, Arizona, USA.,Department of Child Health, University of Arizona College of Medicine-Phoenix, Phoenix, Arizona, USA.,Department of Surgery, Mayo Clinic College of Medicine and Science, Phoenix, Arizona, USA
| | - J Craig Egan
- Division of Pediatric Surgery, Phoenix Children's Hospital, Phoenix, Arizona, USA.,Department of Child Health, University of Arizona College of Medicine-Phoenix, Phoenix, Arizona, USA.,Department of Surgery, Mayo Clinic College of Medicine and Science, Phoenix, Arizona, USA
| | - Lisa E McMahon
- Division of Pediatric Surgery, Phoenix Children's Hospital, Phoenix, Arizona, USA.,Department of Child Health, University of Arizona College of Medicine-Phoenix, Phoenix, Arizona, USA.,Department of Surgery, Mayo Clinic College of Medicine and Science, Phoenix, Arizona, USA
| | - Mark S Molitor
- Division of Pediatric Surgery, Phoenix Children's Hospital, Phoenix, Arizona, USA.,Department of Child Health, University of Arizona College of Medicine-Phoenix, Phoenix, Arizona, USA.,Department of Surgery, Mayo Clinic College of Medicine and Science, Phoenix, Arizona, USA
| | - Jae-O Bae
- Division of Pediatric Surgery, Phoenix Children's Hospital, Phoenix, Arizona, USA.,Department of Child Health, University of Arizona College of Medicine-Phoenix, Phoenix, Arizona, USA.,Department of Surgery, Mayo Clinic College of Medicine and Science, Phoenix, Arizona, USA
| | - Daniel J Ostlie
- Division of Pediatric Surgery, Phoenix Children's Hospital, Phoenix, Arizona, USA.,Department of Child Health, University of Arizona College of Medicine-Phoenix, Phoenix, Arizona, USA.,Department of Surgery, Mayo Clinic College of Medicine and Science, Phoenix, Arizona, USA
| | - Benjamin E Padilla
- Division of Pediatric Surgery, Phoenix Children's Hospital, Phoenix, Arizona, USA.,Department of Child Health, University of Arizona College of Medicine-Phoenix, Phoenix, Arizona, USA.,Department of Surgery, Mayo Clinic College of Medicine and Science, Phoenix, Arizona, USA
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11
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Chen D, Ding Y, Zhu W, Fang T, Dong N, Yuan F, Guo Q, Wang Z, Zhang J. Frailty is an independent risk factor for postoperative pulmonary complications in elderly patients undergoing video-assisted thoracoscopic pulmonary resections. Aging Clin Exp Res 2022; 34:819-826. [PMID: 34648174 DOI: 10.1007/s40520-021-01988-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 09/19/2021] [Indexed: 01/25/2023]
Abstract
BACKGROUND Although frailty as a common geriatric syndrome is associated with postoperative complications, its relationship with postoperative pulmonary complications (PPCs) following pulmonary resections in elderly patients is unclear. AIMS To investigate the relationship between frailty and PPCs in elderly patients undergoing video-assisted thoracoscopic pulmonary resections and explore the effect of the addition of frailty assessment to PPC risk index and ASA on their predictive ability. METHODS In a prospective cohort study, we measured frailty status using the FRAIL scale in elderly patients undergoing video-assisted thoracoscopic pulmonary resections. Multivariate analysis was used to identify the relationship between frailty and PPCs. Receiver operating characteristic curves were used to examine the predictive power of frailty and other assessment tools. RESULTS 227 patients were analyzed in the study. The prevalence of PPCs was 24.7%. Significant differences between patients with and without PPCs were observed in the following aspects: BMI, smoking, COPD, respiratory infection within the last month, FEV1/FVC ratio, creatinine, ASA, frailty and PPC risk index (p < 0.05, respectively). After adjusting for all covariates, frailty was significantly related to PPCs in elderly patients (odds ratio: 6.33, 95% confidence interval: 2.45-16.37). Combined with frailty assessment, the area under the curve for ASA class and PPC risk index was increased to 0.759 (95% CI 0.687-0.831) and 0.821 (95% CI 0.758-0.883). CONCLUSIONS Frailty was associated with PPCs in elderly patients undergoing video-assisted thoracoscopic pulmonary resections. Combined with the frailty assessment, the predictive power of the PPC risk index and ASA class was improved.
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Affiliation(s)
- Dandan Chen
- Department of Anesthesiology, Affiliated Hospital of Jiangnan University, No. 1000, Hefeng Road, Wuxi, 214125, People's Republic of China
| | - Yi Ding
- Department of Anesthesiology, Affiliated Hospital of Jiangnan University, No. 1000, Hefeng Road, Wuxi, 214125, People's Republic of China
| | - Wenlan Zhu
- Department of Anesthesiology, Affiliated Hospital of Jiangnan University, No. 1000, Hefeng Road, Wuxi, 214125, People's Republic of China
| | - Tingting Fang
- Intensive Care Unit, Affiliated Hospital of Jiangnan University, Wuxi, People's Republic of China
| | - Nan Dong
- Department of Anesthesiology, Affiliated Hospital of Jiangnan University, No. 1000, Hefeng Road, Wuxi, 214125, People's Republic of China
| | - Fenglai Yuan
- Institute of Integrated Chinese and Western Medicine, Affiliated Hospital of Jiangnan University, Wuxi, People's Republic of China
| | - Qin Guo
- Clinical Laboratory, Affiliated Hospital of Jiangnan University, Wuxi, People's Republic of China
| | - Zhiqiang Wang
- Department of Thoracic Surgery, Affiliated Hospital of Jiangnan University, Wuxi, People's Republic of China
| | - Jiru Zhang
- Department of Anesthesiology, Affiliated Hospital of Jiangnan University, No. 1000, Hefeng Road, Wuxi, 214125, People's Republic of China.
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Macieira CL, Chiavegato LD, Garcia IFF, Lunardi AC. Perioperative care for major elective surgery: a survey of Brazilian physiotherapists. FISIOTERAPIA EM MOVIMENTO 2022. [DOI: 10.1590/fm.2022.35106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Abstract Introduction: Major surgeries are highly complex procedures and have a higher incidence of respiratory morbidity and mortality compared to other types of surgery. Postoperative pulmonary complications (PPC) are common after such surgeries and are associated with increased hospital stay, health care costs and surgical patient mortality. Objective: To investigate the most commonly used physical therapy techniques for the prevention and treatment of PPC among thoracic and abdominal surgery patients in all regions of Brazil. Methods: A total of 489 randomly selected physiotherapists who provided perioperative care for patients undergoing elective abdominal, thoracic or cardiac surgeries participated in this study. A questionnaire with nine questions about routine care and therapeutic choices for the surgical population was developed and assessed by 10 specialists before being administered to the physiotherapists. Results: Among the physiotherapists (63% with at least 5 years of experience with surgical patients), 50.9% considered the patient’s surgical risk in their treatment either always or often. A total of 53.8% patients were treated by the physiotherapist following a physician’s prescription. The most mentioned physical therapy techniques used to prevent PPC were postoperative mobilization/exercises (59.3%), postoperative lung expansion (52.8%), and preoperative advice (50.7%). In addition, 80.6% of the physiotherapists believe that incentive spirometry prevents PPC, while 72.8% expected this effect from positive airway pressure devices. Conclusion: Most physiotherapists in Brazil who work with surgical patients offer preoperative professional advice, use postoperative early mobilization and lung expansion techniques to prevent PPC, and consider the patient's surgical risk during treatment. In addition, some physical therapy sessions are routinely performed preoperatively.
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Alwekhyan SA, Alshraideh JA, Yousef KM, Hayajneh F. Nurse-guided incentive spirometry use and postoperative pulmonary complications among cardiac surgery patients: A randomized controlled trial. Int J Nurs Pract 2021; 28:e13023. [PMID: 34676618 DOI: 10.1111/ijn.13023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Revised: 09/11/2021] [Accepted: 09/25/2021] [Indexed: 11/29/2022]
Abstract
AIMS To assess the effect of nurse-guided use of incentive spirometer on postoperative oxygenation and pulmonary complications after coronary artery bypass graft surgery. BACKGROUND Deep breathing exercises have been shown to improve postoperative lung expansion and reduce pulmonary complications. An incentive spirometer is a deep breathing exercises device that imitates continuous sigh-like maximal inspiration. DESIGN Randomized control trial, two groups nonblinded parallel design. METHODS A total of n = 89 eligible patients were randomized to either control or intervention group. Patients in the intervention group received bihourly nurse-guided incentive spirometry for 48-h postextubation. The endpoints were: the number and duration of hypoxic events during the first 24-hr postsurgery, pneumonia and pulmonary function parameters. Data were collected May to September 2019. RESULTS Patients in the intervention group had a significantly lower mean number of hypoxic events with shorter duration and shorter length of stay in the hospital and the ICU. Patients in the intervention group also had greater postoperative forced expiratory volume in 1 second. CONCLUSION Nurse-guided use of the incentive spirometer reduces the risk of pulmonary complications and hospital length of stay after cardiac surgery.
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Affiliation(s)
| | | | - Khalil Moh'd Yousef
- School of Nursing, University of Jordan, Amman, Jordan.,School of Humanities, Social Sciences and Health University of Wollongong, Dubai
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The Impact of Incentive Spirometry on Shoulder Tip Pain in Laparoscopic Cholecystectomy: A Randomized Clinical Trial. SURGICAL LAPAROSCOPY, ENDOSCOPY & PERCUTANEOUS TECHNIQUES 2021; 32:14-20. [PMID: 34570072 DOI: 10.1097/sle.0000000000001012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Accepted: 08/12/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND Shoulder pain is among the early postlaparoscopic symptoms related to carbon dioxide used for pneumoperitoneum, which remains in the abdominal cavity. Therefore, incentive spirometry (IS) is a novel technique to alleviate this pain following laparoscopic cholecystectomy (LC). The present study was designed to investigate if the use of IS after LC would relieve shoulder tip pain, and determine the amount of postoperative opioid analgesics utilized. MATERIALS AND METHODS This randomized clinical trial was conducted on patients who were clinically diagnosed with cholecystitis, and underwent LC. Accordingly, group I patients (n=42) received IS (including 10 deep breaths with a spirometer in sitting or semisitting positions) in full consciousness every 2 hours starting at 2 hours after surgery, but group II patients (n=42) did not have respiratory physiotherapy. The postoperative shoulder pain after the surgery was further evaluated by a numerical rating scale (NRS). RESULTS At 4, 8, 12, 24, and 48 hours following LC, the NRS pain scores significantly reduced in group I compared with group II. In addition, the results of the repeated measures analysis of variance indicated significantly lower NRS pain scores within the first 48 hours after LC in group I compared with group II. Consequently, the study findings showed a significantly higher percentage of cases in group II, requiring postoperative analgesics, in comparison with group I. CONCLUSIONS IS decreased the severity of shoulder tip pain after LC with no complications. Thus, IS may be considered as a viable alternative to other laparoscopic interventions. However, still further studies are necessary to evaluate its efficacy compared with other techniques.
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